Have a Question? Call Us: (800) 867-2040

STOP DIRECT DEPOSIT (ONLINE)

If you are human, leave this field blank.

This form is protected by a state-of-the-art, multi-encrypted secure server

IMPORTANT! Please double check your information for accuracy before submitting.

Name *

First

Name *

Last

Last four of your social security # XXX-XX- *

Last four (only)

I am authorizing WORKERS.COM to stop depositing my wages into my bank account, effective immediately.

I authorize

reCAPTCHA is required.

Date *

Signature *

Signature is required.

(Use mouse pointer, e-pen or finger to sign)

1070 Concord Avenue, Suite 112
Concord, CA 94520

|

|